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Younger women survive ovarian cancer better

Posted Sep 07 2008 8:10pm

Younger women survive ovarian cancer better

London - Younger women with ovarian cancer have better survival rates than older patients, even if they have surgery to conserve their fertility, scientists said on Tuesday.

Ovarian cancer is known as the silent killer because it is often not detected until the illness is in an advanced stage and more difficult to treat.

But an American study showed that 59 percent of women diagnosed between the ages of 30-60 were still alive five years later, compared to only 35 percent of older women with the illness.

Ovarian cancer is rare in women under 30 but the five-year survival rate for that age group was 79 percent.

"We found that younger patients have a better survival," said Dr John Chan of Stanford University in California, in the British Journal of Cancer.

Although the improved survival of young women could be due in part to an earlier diagnosis and a lower grade of tumour, Chan and his team believe there may be other underlying, unknown factors linked to the improved prognosis.

The researchers also found no significant difference in the survival of women of child-bearing age who had been treated with surgery to conserve their fertility and those who had their wombs removed.

"Our results suggest that more pre-menopausal women diagnosed with ovarian cancer can be considered for fertility-sparing surgery," said Chan.

"Also, given the overall encouraging survival rates in this age group, we can potentially make a significant impact on the outcomes of these young women with novel strategies," he added.

About 190 000 new cases of ovarian cancer occur worldwide each year and 114 000 women die of the illness. The highest rates are reported in Scandinavia, Eastern Europe, the United States and Canada, according to the International Agency for Research on Cancer (IARC) in Lyon, France.

A family history of the illness is the most important risk factor and occurs in 5-10 percent of cases. The illness is influenced by hormones. Early puberty, late menopause, a history of breast cancer and not having children may increase the odds of developing it.

Chan's findings are based on an analysis of the medical history of 28 000 American women who had been diagnosed with ovarian cancer between 1988 and 2001.

The scientists called for more research into the potential biological and molecular differences that could account for the disparity in survival rates among the age groups.

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Articles like this one make me wonder if maybe I could have had more conservative surgery which would have spared my uterus and made pregnancy a possibility with donor eggs or embryos. Maybe that wouldn't have been an option at all -- the cancer had spread to my uterus and maybe leaving it behind for chemo to treat would have compromised my chances of survival too much. This article doesn't indicate if young women with spread to pelvic structures beyond the ovaries can feasibly have conservative surgery with low-grade (in my case, grade 1) tumours. It doesn't indicate to what extent chemotherapy is an adequate defence against larger remaining tumours in younger women with low-grade cancers or what type of tumours in young women have the best survival rates. It doesn't talk about how different ovarian cancers tend to spread and grow.

I am sure the surgery I had gave me the best chance for survival, but I wonder how much lower my chances would have been if the uterus was left in place. Would it have been an insignificant difference for someone of my age with my tumour type? Would it have been possible to remove the cancerous ovaries and leave the uterus? Is it even worth asking myself or someone else these questions? What difference could the answers possibly make -- the surgery long past, the decisions made can't be unmade. But I do wonder, and I know that if some day I find out I could have had a more conservative surgery, I will probably feel my loss as a more recent pain. That scares me. It's a constant battle to stay ahead of the mess I've left behind. It's easier than I'd like to get tangled in it again.

Meh. I shouldn't dwell too much on articles which lack the answers to my questions.

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